Cardiology Department, Montpellier University Hospital, 34295 Montpellier, France; Inserm U1046, CNRS UMR 9214, PhyMedExp, 34090 Montpellier, France.
Cardiology Department, Lille University Hospital, 59000 Lille, France.
Arch Cardiovasc Dis. 2019 Dec;112(12):773-780. doi: 10.1016/j.acvd.2019.06.009. Epub 2019 Sep 3.
Cardiogenic shock is a critical clinical situation, requiring rapid diagnosis, aetiological assessment and immediate initiation of therapy. In industrialized countries, aortic stenosis is the most frequent left-sided valvulopathy, followed by mitral regurgitation, aortic regurgitation and mitral stenosis. Severe valvulopathies leading to cardiogenic shock are not rare conditions, but few data are available on their optimal management. Therapeutic options for such critical conditions include inotropic agents, mechanical support (when feasible) and rapid valvular intervention. Although surgery remains the gold-standard treatment for severe valvular disease, mortality is frequently prohibitive in the setting of cardiogenic shock, necessitating consideration of alternative therapies. Percutaneous management of valvulopathies has emerged as an alternative treatment for patients deemed at high surgical risk in a stable condition. Although few published data are available, catheter-based interventions may be feasible in the cardiogenic shock setting. This review offers an overview of different valvulopathies in the cardiogenic shock setting, and summarizes the different therapeutic options currently available in such critical situations.
心原性休克是一种危急的临床情况，需要快速诊断、病因评估和立即开始治疗。在工业化国家，主动脉瓣狭窄是最常见的左侧瓣膜病，其次是二尖瓣反流、主动脉瓣反流和二尖瓣狭窄。导致心原性休克的严重瓣膜病并不少见，但关于其最佳治疗方法的数据很少。此类危急情况的治疗选择包括正性肌力药物、机械支持（在可行时）和快速瓣膜介入。尽管手术仍然是严重瓣膜病的金标准治疗方法，但在心原性休克的情况下，死亡率通常很高，因此需要考虑替代治疗方法。对于处于稳定状态但被认为手术风险较高的患者，经皮瓣膜病管理已成为一种替代治疗方法。尽管可用的发表数据很少，但在心原性休克情况下，导管介入可能是可行的。本综述概述了心原性休克情况下的不同瓣膜病，并总结了此类危急情况下目前可用的不同治疗选择。
